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. 2018 Sep;41(9):1170-1176.
doi: 10.1002/clc.23001. Epub 2018 Sep 20.

The role and outcome of cardiac rehabilitation program in patients with atrial fibrillation

Arwa Younis  1   2 , Ella Shaviv  1   2 , Eyal Nof  1   2 , Ariel Israel  1   2 , Anat Berkovitch  1   2 , Ilan Goldenberg  1   2   3 , Michael Glikson  1   4 , Robert Klempfner  1   2 , Roy Beinart  1   2   5
Affiliations

The role and outcome of cardiac rehabilitation program in patients with atrial fibrillation

Arwa Younis et al. Clin Cardiol. 2018 Sep.

Abstract

Background: Atrial fibrillation (AF) is associated with diminished cardiac function, and exercise tolerance.

Hypothesis: We sought to investigate the role of cardiac rehabilitation program (CR) in patients with AF.

Methods: The study included 2165 consecutive patients that participated in our CR program between the years 2009 to 2015. All were evaluated by a standard exercise stress test (EST) at baseline, and upon completion of at least 3 months of training. Participants were dichotomized according to baseline fitness and the degree of functional improvement. The combined primary end point was cardiac related hospitalization or all-cause mortality.

Results: A total of 292 patients had history of AF, with a mean age of 68 ± 9 years old, 76% of which were males. The median predicted baseline fitness of AF patients was significantly lower compared to non-AF patients (103% vs 122%, P < 0.001, respectively). Prominent improvement was achieved in the majority of the patients in both groups (64% among AF patients and 63% among those without AF). Median improvement in fitness between stress tests was significantly higher in patients with AF (124% vs 110%, P < 0.001, respectively). Among AF patients, high baseline fitness was associated with a lower event rates (HR 0.40; 95%CI 0.23-0.70; P = 0.001). Moreover, prominent improvement during CR showed a protective effect (HR 0.83; 95% CI 0.69-0.99; P = 0.04).

Conclusion: In patients with AF participating in CR program, low fitness levels at baseline EST are associated with increased risk of total mortality or cardiovascular hospitalization during long-term follow-up. Improvement on follow-up EST diminishes the risk.

Keywords: atrial fibrillation; cardiac rehabilitation; exercise stress test; fitness level.

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Conflict of interest statement

The authors declare no potential conflict of interests.

Figures

Figure 1
Figure 1
A, Initial and last percentage of the predicted METs among patients wit and without AF undergoing cardiac rehabilitation. B, The percentage change [([Follow‐up predicted METs−Baseline predicted METs]/Baseline predicted METs) * 100] among patients with AF and those without it
Figure 2
Figure 2
Kaplan Meier survival analyses showing the risk for MACE and/or all‐cause mortality among patients with AF (A) and without AF (B) based on their improvement
Figure 3
Figure 3
Kaplan‐Meier survival analysis showing the risk for MACE and/or all‐cause mortality among patients with AF based on their baseline fitness level and their percentage of improvement
See this image and copyright information in PMC

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